Cost-Utility Analysis of Screening Intervals for Diabetic Retinopathy in Patients With Type 2 Diabetes Mellitus
Abstract
Context Annual eye screening for patients with diabetes mellitus is frequently proposed as a measure of quality of care. However, the benefit of annual vs less frequent screening intervals has not been well evaluated, especially for low-risk patients. Objective To examine the marginal cost-effectiveness of various screening intervals for eye disease in patients with type 2 diabetes, stratified by age and level of glycemic control. Design Markov cost-effectiveness model. Setting and participants Hypothetical patients based on the US population of diabetic patients older than 40 years from the Third National Health and Nutrition Examination Survey. Main outcome measures Patient time spent blind, quality-adjusted life-years (QALYs), and costs of annual vs less frequent screening compared by age and level of hemoglobin A1c. Results Retinal screening in patients with type 2 diabetes is an effective intervention; however, the risk reduction varies dramatically by age and level of glycemic control. On average, a high-risk patient who is aged 45 years and has a hemoglobin A1c level of 11% gains 21 days of sight when screened annually as opposed to every third year, while a low-risk patient who is aged 65 years and has a hemoglobin A1c level of 7% gains an average of 3 days of sight. The marginal cost-effectiveness of screening annually vs every other year also varies; patients in the high-risk group cost an additional $40530 per QALY gained, while those in the low-risk group cost an…
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Patients with referable DR who are missed face a 4.5-fold higher annual risk of progressing to blindness compared to those who receive appropriate treatment.
“From a public health perspective, reduced sensitivity in DR screening results in misdiagnosed patients with referable DR, missing opportunity for timely intervention, and facing a 4.5-fold higher risk of progressing to blindness annually when compared to those who receive appropriate treatment20,21.”
From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [20]
Reduced sensitivity in DR screening results in missed diagnosis of referable DR and missed timely intervention.
“From a public health perspective, reduced sensitivity in DR screening results in misdiagnosed patients with referable DR, missing opportunity for timely intervention, and facing a 4.5-fold higher risk of progressing to blindness annually when compared to those who receive appropriate treatment20,21.”
From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [20]
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“For example, risk of retinopathy and eventual blindness can be stratified by level of glycemic control.(12,19-21) Thus, we sought to evaluate whether hemoglobin A1c level can be used to effectively stratify the frequency of diabetic retinal screening and improve the efficiency and costeffectiveness of screening.”
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- Authors
- Vijan, S.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Vijan, Sandeep
- ORCID
- Vijan, Sandeep
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2000-02-16
- Volume
- 283
- Issue
- 7
- Pages
- 889
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2061918877
- Cited by
- 295
- References
- 2
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 9 · 2023: 17 · 2022: 7 · 2021: 6 · 2020: 7 · 2019: 7 · 2018: 10 · 2017: 6 · 2016: 10 · 2015: 16 · 2014: 10 · 2013: 14 · 2012: 17
- FWCI
- 19.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P60DK020572, P60 DK 20572)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- diabetic retinopathy, type 2 diabetes, retinal screening, screening frequency, cost-effectiveness, quality-adjusted life years, glycemic control, HbA1c, blindness prevention, age-stratified risk, healthcare quality standards
- MeSH terms
- Adult, Aged, Blood Glucose, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Glycated Hemoglobin, Humans, Markov Chains, Mass Screening, Middle Aged, Population Surveillance, Risk Factors, United States, Multivariate Analysis, Quality-Adjusted Life Years
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